<!DOCTYPE html>
<!--
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To change this template file, choose Tools | Templates
and open the template in the editor.
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<html>
    <head>
        <title>TODO supply a title</title>
        <meta charset="UTF-8">
        <meta name="viewport" content="width=device-width, initial-scale=1.0">
        <link rel="stylesheet" type="text/css" href="./bootstrap/css/bootstrap.css" media="screen"/>
        <link rel="stylesheet" href="bootstrap-3.1.1-dist/css/bootstrap.css" type="text/css">
        <link rel="stylesheet" href="css.css" type="text/css">
        <link rel="stylesheet" href="blueberry.css" type="text/css">


    </head>
<body id="fond">
    <div id="contenair" > 
        <div id="header">
        <div id="logo"></div>
        <div id="formbody">
                <!--                    <form method="post">
                                        <input name="ident" id="ident" size="10" placeholder="identifiant">
                                        <input type="password" name="pass" id="pass" size="10" placeholder="mot de passe">
                                        
                                    </form>-->

        </div>
            <!--                <img id="fleche" src="image/flecheconnexion.png">-->
        <div id="panier"><img id="caddie"  src="image/caddie.png">Mon panier
            <div id="traitp"><img  src="image/traitpanier.png"></div>
            <div id="rec1"></div>
            <div id="rec2"></div>
            <img id="flechep" src="image/flechepanier.png">
        </div>
        </div>

        <div class="container-fluid">
            <div class="row-fluid">
                <div class="span8">
                    <h1>Formulaire d'inscription</h1>
                </div>
                <div class="span4 pull-right">&nbsp;</div>
            </div>

            <div class="row-fluid">
                <form class="well span12">
                    <div class="row-fluid">
                        <div class="span12">

                            <div class="span3"></div>
                            <div class="span3">
                                <label>Civilité </label>              
                                <select>
                                    <option>      </option>   
                                    <option> Mr</option>
                                    <option> Mme</option>
                                    <option> Mlle</option>
                                </select>
                            </div>
                        </div>
                        <div class="row-fluid">
                            <div class="span12">
                                <label>Nom</label>
                                <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                            </div>

                            <div class="row-fluid">
                                <div class="span12">
                                    <label>Prénom</label>
                                    <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                </div>

                                <div class="row-fluid">
                                    <div class="span12">
                                        <label>Date de naissance</label>
                                        <input type="text" placeholder = "jj/mm/aaaa" size = "50" class="span8"/> 
                                    </div>

                                    <div class="row-fluid">
                                        <div class="span12">
                                            <label>Adresse</label>
                                            <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                        </div>

                                        <div class="row-fluid">
                                            <div class="span12">
                                                <label>Code Postal</label>
                                                <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                            </div>
                                            <div class="row-fluid">
                                                <div class="span12">
                                                    <label>Ville</label>
                                                    <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                </div>

                                                <div class="row-fluid">
                                                    <div class="span12">
                                                        <label>Téléphone</label>
                                                        <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                    </div>

                                                    <div class="row-fluid">
                                                        <div class="span12">
                                                            <label>E-mail</label>
                                                            <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                        </div>
                                                        <div class="row-fluid">
                                                        <div class="span12">
                                                            <label>Confirmer E-mail</label>
                                                            <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                        </div>

                                                        <div class="row-fluid">
                                                            <div class="span12">
                                                                <label>Mot de passe</label>
                                                                <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                            </div>
                                                            <div class="row-fluid">
                                                            <div class="span12">
                                                                <label>Confirmer Mot de passe</label>
                                                                <input type="text" placeholder = "Champs Obligatoire" size = "50" class="span8"/> 
                                                            </div>

                                                            <div class="row-fluid">
                                                                <div class="form-actions pull-right">
                                                                    <button type="submit" class="btn btn-primary">Valider</button>
                                                                </div>
                                                            </div>
                                                            </form>
                                                        </div>
    </div>                                          
   
    </body>
</html>
